Understanding Migraines and Headache Pain: A Guide on how to Manage

Some could argue Southern Alberta is the migraine capital of Canada due to the unique environmental factors we experience such as barometric air pressure changes. From chinooks to our dry climate.

Headaches and migraines are disruptive and frustrating. Understanding the differences between them and recognizing potential triggers can empower you to manage your pain effectively. Let’s explore helpful information about head pain and how to find relief.

Understanding the Difference: Migraines vs. Headaches

Migraines: The More Intense, Long-lasting Pain

Migraine attacks often come in stages:

• Prodrome: This early phase can start hours or days before the headache, with symptoms like cravings, fatigue, irritability, yawning, and frequent urination.
• Aura: This phase involves visual disturbances or numbness and occurs shortly before the headache.
• Migraine Attack: Pain typically begins on one side of the head. It's important to take medication early to prevent escalation.
• Intense Pain Phase: The headache peaks, often with nausea and sensitivity to light and sound. Medication may be less effective if delayed.
• Postdrome: As the migraine subsides, lingering effects like exhaustion or a "hangover" feeling may persist. 

Migraines often come with:

• Throbbing pain, typically on one side of the head
• Nausea or vomiting
• Sensitivity to light, sound, or smells
• Visual disturbances, such as seeing flashes of light

These symptoms can last anywhere from a few hours to several days, significantly impacting your ability to function.

Headaches: The More Common Discomfort

In contrast, headaches usually present as:

• Dull, aching pain on both sides of the head
• A sensation of tightness around the forehead
• Mild neck and shoulder tension

Common Triggers for Head Pain

Environmental Factors

Living in Calgary and in Southern Alberta, there are unique triggers that can contribute to head pain:

• Chinook Winds: These warm, dry winds are a well-documented trigger for migraines in Alberta. About 1 in 3 migraine sufferers experience more attacks either on pre-chinook days or during chinook winds, especially when wind speeds exceed 38 km/h.
• Wildfire Smoke: During wildfire season, poor air quality can lead to headaches, especially for those sensitive to pollution.
• Dry Weather: Alberta's semi-arid climate can contribute to dehydration and dry eyes, both well-known migraine triggers. More on dehydration later in this article.

Hormonal Fluctuations

Hormonal fluctuations, particularly involving estrogen and progesterone, can significantly impact the occurrence of migraines.

• Neurotransmitter Fluctuations: Estrogen influences neurotransmitter levels, including serotonin, which plays a crucial role in pain perception. Higher estrogen levels can lead to increased serotonin, while progesterone can enhance the effects of GABA, a neurotransmitter that helps calm neural activity. When estrogen levels drop, the sudden decrease in serotonin can trigger migraines, especially for those who are sensitive to these changes.
• Vascular Effects: Estrogen promotes vasodilation (widening of blood vessels), while progesterone can cause vasoconstriction (narrowing of blood vessels). The balance between these hormones can lead to changes in blood flow to the brain, contributing to headache pain.
• Neural Excitability: Estrogen enhances the excitability of neurons, making the brain more susceptible to migraine triggers. Conversely, progesterone tends to have a calming effect on the nervous system. Fluctuations in these hormones can affect how the brain responds to various triggers, increasing the likelihood of migraines.
• Inflammation: Both hormones can modulate inflammatory responses in the body. Estrogen generally has anti-inflammatory effects, while progesterone's role can vary depending on the context. Changes in the levels of these hormones, particularly the drop in estrogen, can lead to increased inflammation, which may contribute to headache pain.

Understanding the interplay between estrogen and progesterone can help individuals identify potential migraine triggers related to hormonal changes, particularly during menstrual cycles, pregnancy, or menopause.

Vision Issues

Prolonged screen time can lead to eye strain and headaches, especially if vision problems are uncorrected. Regular eye check-ups are essential for maintaining good vision.

Sleep Disturbances

• Irregular Sleep Patterns: Inconsistent sleep schedules, such as varying bedtimes and wake-up times, can disrupt the body's natural circadian rhythm. This disruption can lead to headaches, as the brain's regulatory systems are thrown off balance.
• Insufficient Sleep: Not getting enough sleep can lead to increased stress and reduced pain tolerance, both of which can contribute to the onset of migraines and tension headaches.
• Poor Sleep Quality: Even if the duration of sleep is adequate, poor sleep quality—characterized by frequent awakenings or restless sleep—can prevent the body from reaching the restorative stages of sleep necessary for recovery and repair, potentially triggering headaches.
• Sleep Disorders: Conditions like sleep apnea, insomnia, or restless legs syndrome can lead to chronic sleep deprivation, increasing the risk of frequent headaches and migraines.

Food Triggers and Additives

While triggers can vary from person to person, some common culprits include:

• Tyramine-Rich Foods: Aged cheeses, cured meats, and fermented foods contain tyramine, which can affect blood flow and trigger migraines in some people.
• Preservatives and Enhancers: Additives like monosodium glutamate (MSG), nitrates, and sulfites, found in various processed foods, may provoke headaches in sensitive individuals.
• Artificial Sweeteners: Some people report headaches after consuming artificial sweeteners, particularly aspartame, which is common in diet sodas and sugar-free products.
• Caffeine: While caffeine can help relieve headaches for some, it can be a trigger for others. Caffeine withdrawal can also cause headaches.
• Alcohol: Red wine, beer, and spirits can trigger migraines in some people, possibly due to their alcohol content or other compounds like histamines and sulfites.
• Food Colourings: Certain artificial food dyes, especially Yellow No. 6 and Red No. 40, have been associated with headaches in some individuals.
• Chocolate: Contains both caffeine and other compounds that may trigger migraines in some people.

It's important to note that food triggers can be highly individual. Keeping a food diary can help identify personal triggers. If you suspect certain foods are causing your headaches, consider eliminating them from your diet for a period and then reintroducing them one at a time to pinpoint the culprit.

Always consult with a healthcare provider before making significant changes to your diet, especially if you have other health conditions or are on medication. 

Stress and Anxiety as Migraine Triggers

• Stress: Stress can lead to the release of stress hormones, such as cortisol, which may alter neurotransmitter levels, including serotonin. These changes can increase the likelihood of migraines by affecting pain pathways in the brain.
• Muscle Tension: Anxiety often results in muscle tension, particularly in the neck, shoulders, and jaw. This tension can contribute to tension-type headaches and exacerbate migraine symptoms.
• Sleep Disturbances: Both stress and anxiety can disrupt sleep patterns, leading to insufficient or poor-quality sleep. Lack of restful sleep is a well-known trigger for headaches and migraines.
• Lifestyle Factors: Stress and anxiety can influence lifestyle choices, such as irregular eating habits, increased caffeine consumption, and reduced physical activity, all of which can contribute to headache frequency and severity.
• The Vicious Cycle: Migraines themselves can be a source of stress and anxiety, creating a cycle where stress triggers headaches, and the pain and disruption from headaches increase stress levels.

Managing stress and anxiety is crucial for reducing the frequency and severity of migraines and headaches. Techniques such as regular exercise, mindfulness practices, and relaxation techniques like yoga or meditation can be beneficial. Additionally, seeking professional support from therapists or counselors can help individuals develop coping strategies and address underlying anxiety issues.

Dehydration

Dehydration is a common trigger for both migraines and headaches. Here's how it can impact head pain:

• Fluid and Electrolyte Balance: The body requires a proper balance of fluids and electrolytes to function optimally. Dehydration occurs when you lose more fluids than you take in, disrupting this balance and potentially leading to headaches.
• Brain Volume Changes: When the body is dehydrated, the brain can temporarily contract or shrink due to fluid loss. This contraction may cause the brain to pull away from the skull, activating pain receptors and resulting in a headache.
• Increased Sensitivity: Dehydration can heighten the body's sensitivity to pain, making existing headaches feel more intense or triggering new ones.
• Associated Symptoms: Dehydration headaches often come with other signs of dehydration, such as extreme thirst, dark urine, dizziness, fatigue, and a dry mouth.

Migraine and Headache Treatment Options Available

Managing migraines and headaches effectively often involves a combination of medications and lifestyle changes.

Over-the-Counter (OTC) Medications

• Pain Relievers: Ibuprofen (Advil) and naproxen (Aleve) can help reduce inflammation and pain. Acetaminophen (Tylenol) is effective for mild pain relief.

Prescription Medications

• Triptans: These medications, such as sumatriptan (Imitrex) and rizatriptan (Maxalt), are specifically designed to treat migraines by blocking pain pathways in the brain.
• Anti-nausea Drugs: Medications like metoclopramide (Reglan) can help if your migraine is accompanied by nausea.

Preventive Medications

• Beta-blockers: Propranolol can help reduce the frequency of migraines.
• Antidepressants: Amitriptyline is sometimes used to prevent migraines.
• Antiseizure Drugs: Topiramate (Topamax) is another option for reducing migraine frequency.

Botox Injections

• Botox: Approved for chronic migraines, Botox injections can help reduce the frequency and severity of attacks by blocking pain signals.

Newer Treatments

• CGRP Inhibitors: These are a newer class of medications that target a protein involved in migraine attacks. Examples include Aimovig, Ajovy, and Emgality, which are available in Alberta.

Tips for Managing Headaches

Here are some practical strategies to help manage headaches effectively:

1. Keep a Headache Diary: Tracking symptoms can help identify personal triggers and patterns.
2. Stay Informed About Weather Patterns: Being aware of changes, especially chinook winds, may help you anticipate potential headaches.
3. Maintain a Consistent Sleep Schedule: Aim for 7-9 hours of quality sleep each night to support overall health.
4. Stay Hydrated: Drinking plenty of water throughout the day can help prevent dehydration, a common headache trigger.
5. Practice Stress Management: Incorporate relaxation techniques, such as deep breathing or meditation, into your routine.
6. Take Regular Breaks: If you work at a computer, remember to rest your eyes and stretch periodically.

When to Seek Medical Help

If you experience any of the following, it’s important to consult a healthcare professional:

• New or severe headaches
• Headaches accompanied by fever, stiff neck, confusion, or neurological symptoms
• Headaches following a head injury

Your Pharmacist, Support for Migraines and Headaches

Your pharmacist is a valuable resource for treating migraines and headaches. nuPharma pharmacists are accessible for consultations over the phone and can prescribe medications specifically designed for migraines and headache relief.